Obama and Romney: The Future of American Healthcare

The New England Journal of Medicine asked President Obama and former Massachusetts Governor Mitt Romney to “describe their health care platforms and their visions for the future of American health care” and published their statements on the journal’s website. The (roughly) 1,300-word statements released by the two presidential candidates are rather vague, do not address specific issues and sound like political campaign speeches.

Floating (Via Massimo Valiani - Flickr)

President Obama’s statement emphasizes the importance of the Affordable Care Act (also known as “Obamacare”), and criticizes his opponents Mitt Romney and Paul Ryan for how their plans would be detrimental for medical research in the US and for Medicare, as seen in this excerpt:

My opponent in this election, Mitt Romney, has a radically different vision for the future of our health care system — even if it means running from his past as the architect of health reform in Massachusetts. He would begin by repealing Obamacare on day 1. Your patients would once again be charged excessive copays for preventive care, and millions of Americans would be one illness or injury away from bankruptcy. He would undo the progress we are making toward a more coordinated delivery system. Romney and his running mate, Congressman Paul Ryan, have proposed a budget that could force drastic cuts to investment in medical research, eliminating 1600 National Institutes of Health grants and slowing our progress on scientific and medical breakthroughs. They have pledged to turn Medicaid into a block grant and slash its funding by a third — plunging tens of millions more Americans into the ranks of the uninsured and leaving our hospitals and health care providers to grapple with an increasing burden of uncompensated care. And they are committed to ending Medicare as we know it by turning it into a voucher program, with insurance companies set to make millions while seniors and people with disabilities are forced to pay thousands more every year.

Mitt Romney’s statement, on the other hand, does not directly address medical research, but instead focuses on criticizing Obamacare and wants the states to play a bigger role in providing healthcare:

Nor can our society ever turn its back on those who cannot afford the care they need. We will provide support for low-income Americans and those uninsured persons whose preexisting conditions push the cost of coverage too high for them to pay themselves. But my experience as a governor and the lessons from the President's attempt at a one-size-fits-all national solution convince me that it is states — not Washington — that should lead this effort. I will convert Medicaid into a block grant that properly aligns each state's incentives around using resources efficiently. Each state will have the flexibility to craft programs that most effectively address its challenges — as I did in Massachusetts, where we got 98% of our residents insured without raising taxes.

I have to admit that I am underwhelmed by both responses because they just repeat the political rhetoric that we have already heard during the national conventions and other appearances. One problem is that the editors of the journal asked them for very broad statements instead of asking them to address specific questions and solutions. This is in contrast to, for example, the approach of Scientific American and ScienceDebate.org, who asked the candidates 14 specific questions related to science and technology.

The New England Journal of Medicine could have also asked very specific questions about the future of American healthcare. After all, the future of American healthcare does not just depend on health insurance, Medicare and Medicaid. Specific questions for the candidates could have included questions about how they will address the current crisis in the federal funding of medical research, how they want to deal with the growing problem of obesity and diabetes among children, how they intend to improve preventive healthcare for all, how we should facilitate translation of research findings into clinical practice, how we should curb the staggering cost of healthcare or how we can ensure adequate numbers of primary care healthcare providers, especially in underserved areas.

Such specific questions would force the candidates to focus on the same issues and allow the audience to compare and contrast their responses. I hope that in the future, the candidates will be asked more specific questions regarding their vision for American healthcare.

The Future of U.S. Health Care

Andrea Louise Campbell in the Boston Review:

Physician treating a patient.
Red-figure Attic aryballos, ca. 480–470 BC.

The Affordable Care Act is a monumental accomplishment. Thanks to its expansion of health care coverage and new regulations, tens of millions of Americans will feel more secure, knowing that they can seek medical attention when they need it and that they will be protected from the insurance industry’s most egregious practices.
But the reform was very much limited by the American terms of the debate, particularly the enduring belief that markets are always more efficient than government (even though our current private insurance system demonstrates otherwise) and the conviction that any changes to the arrangements of the insured cannot fly. The result is a sprawling, confusing, Gorgon-headed workaround, whose beneficial features are difficult for the typical consumer to discern.
Now that the Act has run the Supreme Court gauntlet, how will it affect the structure and politics of health care going forward? Assuming the ACA survives Republican repeal attempts, does it represent a large step toward a single-payer system? What will happen to the employer-provided sector of health insurance? Will health insurance in the United States settle into a pattern of competing private plans? And will some states really opt out of the ACA’s Medicaid expansion and forgo billions of federal dollars?

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